<<Disclaimer: Verify this information before applying it to your situation.>>

Dear List mates,  I found this information to late to get it into
Phyllis's summary about sleeping pills. Some of this information is from
the book, "From Fatigued to Fantastic" by Jacob Teitelbaum.  He has very
sensible advise about all kinds of things including sleep aids.  Since so
many CD folks also have insomnia & fibromyalgia (FMS) symtpoms I thought
this advise may be helpful for many of us.  Here's what Dr. Teitelbaum
advises about sleep medications (paraphrased):
        There are several approaches to using sleep treatments in CFS/FMS.  Some
doctors use a single medication or treatment and push it up to its
maximum level.  If that works, great; if not, they stop it then switch to
another medication.  Other doctors prefer to use low doses of several
different treatments together until the patient is getting good, solid
sleep regularly.  Dr. Teitelbaum strongly prefers the latter approach,
for two main reasons.  First, people with FMS can be very
medication-sensitive if high doses of medications are used. [No kidding!
LOL!]  Most of a medication's therapudic benefits occur at low doses and
most of the adverse reactions at high doses.  Second, each medication is
cleared out of the body on its own schedule, regardless of whether it is
taken with other medications or alone.  If you take a low dose of a sleep
medication, so that it's out of your body by morning, the blood level may
not be high enough to keep you asleep at night.  But, if you increase the
dose to keep you asleep all night, it may not be cleared out of your body
until 2:00 PM the next day, leaving you feeling very groggy.  If,
however, you combine low doses of four or five different sleep aids, each
of them will be cleared out of your body by morning.  Meanwhile, the
effective blood levels that you have during the middle of the night from
each treatment are additive and will keep you asleep.  Because of this,
most of his patients find that it takes anywhere from three to five
different treatments combined to get seven to nine hours of solid sleep
each night without waking or hangover.
        He has a lot of other very useful advise about sleep hygiene, some of
which I haven't heard of before.  He tells you which sleep medications
promote deep sleep & which don't.
        Also according to Dr. Teitelbaum, any side effects that you may notice
(for the meds listed below) will occur the same day that you take the
medication.  He says he has not seen any "fly now, pay later" side
effects from polonged use.  For Ambien [which contains gluten] and
possibly for Sonata, the computerized information sheet from the
drugstore may note a recommendation from the U.S. FDA that the medication
be used for only seven days.  This is NOT because problems have been seen
with long-term use (such as addiction), but because it is FDA policy for
any sleep medication.  The FDA wants people to learn proper sleep hygiene
instead of taking medication for their insomnia.  This is very
reasonable--except for people with CFIDS/FMS, in which the sleep problem
is caused by the disease process, not poor sleep hygiene.

Magnesium & calcium
Delta wave sleep-inducing tapes
5-HTP
Melatonin
Breath Right nasal strips
Valerian & lemon balm
Passionflower
Kava Kava
St. John's wort
Wild lettuce pills
Dr. Teitelbaum's sleep formula (Dr. Teitelbaum donates profits to
charity)

Zolpidem (Ambien)
Zaleplon (Sonata)
Trazodone (Desyrel)
Clonazepam (Clonopin)
Doxylamine (Unisom for Sleep)
Cyclobenzaprine (Flexeril)
Mirtazapine (Remeron)
Amitriptyline (Elavil)
Alprazolam (Xanax)
Levodopa plus carbidopa (Sinemet 10/100)
Neurontin

With her permission, Donna has allowed me to post her personal sleep
recipe:
        "I have employed the "nightime cocktail" for years on my own.  Found
that it works better than a large dose of one ingredient.  My personal
one consists of 100 mgs of deseryl, 10 mgs of flexeril, and 1 mg of
ativan.  I also take my daily dose of Effexor sr at the same time.  This
combination works great for me.  I have had to be my own "doctor" as I
live in the UP of Mi and there aren't any doctors that are current with
therapies, drug and otherwise for the FM/CFS person."
        My personal choice is 5 mg of amitryptaline plus 25 mg of
diphenhydrammine (Benedryl).  I sleep pretty well with this w/o being
hung over the next morning.  ~Valerie in Tacoma, WA

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